This blog is dedicated to the examination of implausible and potentially harmful claims in the social sciences and mental health fields.
"Nonsense is nonsense, but the study of nonsense is scholarship"--(attributed to Saul Lieberman).

Tuesday, June 11, 2013

There has been little
discussion of associations between unconventional religious beliefs and
alternative psychotherapies (APs), a class of mental health treatments that
lack a systematic evidence basis and that are implausible with respect to
conventional psychological systems. This paper examines the possibility of
defining both religious groups and organizations advocating APs as cultic in
nature. Apparent connections between two specific groups are discussed with
respect to their beliefs about mental health diagnosis and treatment. An AP,
Attachment Therapy, is compared with the “deliverance” practices used by
Pentecostals as a mental health intervention, and a number of parallels are
noted between these examples of an AP and a religious belief system. The
importance of understanding connections between religious beliefs and APs is
underscored by the occurrence of injuries and deaths in association with both
the described approaches.

During many
years of discussion of the meaning of the term “cult”, the focus has generally
been on groups that are unquestionably religious in nature, with an orientation
toward some form of the supernatural. In their discussion of religious cults,
Stark and Bainbridge (1979) offered several useful definitions. They defined
religions as “solutions to questions of ultimate meaning which postulate the
existence of a supernatural being, world, or force, and which further postulate
that this force is active, that events and conditions here on earth are
influenced by the supernatural” (p. 119). Stark and Bainbridge described
religions as “system[s] of general compensators based on supernatural
assumptions” (p. 121), while defining compensators as “postulations of reward
according to explanations that are not readily susceptible to unambiguous
evaluation” (p. 120). The same authors differentiated cults from conventional
religions by noting that cults “do not have a prior tie with another
established religious body in the society” (p. 125), but instead involve an
independent belief system.

Although
many cult-like groups obviously posit forms of supernatural force and of
related compensators, such groups may also focus on issues that are not
self-evidently supernatural. Richardson (1993) used the example of a communist
“cell” as a possible form of a cult. Stark and Bainbridge (1979) mentioned that
Scientology and another belief system had begun as forms of psychotherapy.
Bainbridge (1978), Lewin (1988), Ayella (1998), and Gaydics (2007) all discussed
forms of psychotherapy they considered cult-like in nature. Noll (1994) and
Eros (2004) addressed cult-like groups concerned with C.G.Jung and Sandor
Ferenczi, respectively.

Does
it make sense to think of non-religious belief systems, and particularly of
psychologies, as potentially cultic? How do they compare to cults that clearly
involve the supernatural? Generally, religions contain the seeds of
psychologies in the form of statements about the nature and right actions of
human beings. Psychologies in turn contain elements that may be supernatural
(e.g., some assumptions about the
personality’s survival of bodily death) and which when not supernatural are
likely to be only indirectly observable, or inferable from behavior or
self-report. To borrow Stark and Bainbridge’s terminology, psychologies propose
systems of general compensators (feeling happier, being more productive) based
on those indirectly observable elements that are “not readily susceptible to
unambiguous evaluation”. This unpacking of psychological thought suggests an
overlap with religion; the existence of conventional psychological belief
systems and of other independent systems suggests that the concept of cults, as
discussed by Stark and Bainbridge, can thus also apply to psychological
systems.

Can a specific belief
system that is publicly presented as a psychotherapy be correctly described as
“cultic”? And, if it can, can it be shown to overlap conceptually and
practically, and cooperate rather than compete, with a religious system that
meets many of the criteria used to define cults? This paper will explore those
questions by examining the cult-like nature of an unconventional psychotherapy
for children, called Holding Therapy or Attachment Therapy (Mercer,
Sarner,& Rosa, 2003), and comparing its principles and practices to those
of the “deliverance” beliefs associated with Pentecostalism.

What Are
Alternative Psychotherapies?

Before addressing Holding Therapy/Attachment Therapy as a
specific type of unconventional psychotherapy, it will be helpful to consider
unconventional or alternative psychotherapies in general. Psychological and
medical treatments, however unorthodox, are not usually referred to as cults,
although their supporters’ behavior may closely resemble that of cultic groups,
as will be discussed later in this paper. More generally, unconventional
treatments are categorized as “complementary and alternative” (CAM) medical
practice; although this term has been applied to psychotherapies as well as to
medical techniques, unconventional psychotherapies can more accurately be
referred to as “alternative psychotherapies” (APs) as they are rarely employed
in a complementary manner as adjuvants to conventional treatment.

Over
the last decade, investigations of the connections and overlaps between
religious or spiritual belief and CAM medical practice have become more
frequent. The use of CAM techniques for physical ills has been associated with
race or ethnicity as well as with other client factors (Gillum & Griffith,
2010; Krause, 2011; Sutherland, Poloma, & Pendleton, 2003). In spite of the developing interest of
psychologists in evidence-based practice (Chambless & Hollon, 1998),
following the slightly earlier medical discussion (Sackett et al, 1996) that
underscored CAM as a category of medical treatment, and the description of
categories of unconventional and non-evidence-based “alternative”
psychotherapies analogous to CAM (Mercer & Pignotti, 2007), few
psychologists have considered the possible connections between religious
beliefs and the preference for APs. Instead, psychotherapists have tended to
focus on ways in which clients’ religious or spiritual concerns could be
integrated into conventional therapies (Aten, Mangis, & Campbell, 2010;
Gonsiorek, Pargament, Richards, & McMinn, 2009; Post & Wade, 2009), or
treatment of problems experienced after leaving a high-demand group (Coates,
2010)

A
client’s choice of an unconventional AP, rather than conventional
psychotherapy, is a different issue from the possibility of integrating
religious and psychotherapeutic principles and is a more basic one, as it deals
with an initial choice of treatment and practitioner. Such a choice may be
based on a framework composed of the client’s experience of religious beliefs
and practices, which may be confirmed by existing membership in a cult-like
group. Religious dogmas, legends, and personal experiences form shared
“traditions of belief” (Bennett, 1987) that can provide the metaphors people
employ in attempting to describe or reason about invisible mental or emotional
processes (Danziger, 1997; Lakoff & Johnson, 1980), and thus about the
nature and treatment of mental illness. For example, the use of folklore or
similar informal traditions of belief to provide metaphors about mental or
physical illness is a point discussed by Ellis (2000), in a careful analysis of
the “Satanism scare” of the 1980s. Folkloric metaphors can help confirm beliefs
in mental health interventions when those beliefs are presented in a cult-like
social context.

Metaphors
Characteristic of Alternative Psychotherapies

CAM treatments have been addressed in more
detail than APs have, and it is difficult to consider metaphors associated with
APs without discussion of the analogous unorthodox beliefs about physical
illness. CAM treatments for physical disorders are those which are not only
without a systematic evidence basis, but are implausible in terms of the causal
frameworks that are the foundation of evidence-based medicine (EBM). (An
experimental treatment that lacks an established evidence basis is thus not
considered a CAM practice if it is plausible in terms of conventional medical
assumptions about the natural world.) The frameworks of EBM involve a number of
a priori assumptions about the nature
of the universe. Included are the beliefs that all forces at work in health and
illness are at least potentially describable by natural science and are
physical in nature, and that causal factors work from past to present rather
than the other way around.

CAM
treatments for physical disorders are based on alternative a priori assumptions that allow for non-natural/supernatural
factors’ influence on the body. Homeopathic treatment, for instance, assumes that
substances can be changed in their spiritual nature and made effective by
operations that would conventionally be expected to diminish any effect they
could have. Chiropractic treatment is historically based on the belief in a vis naturae or natural healing principle
that can be blocked by muscular distortions (Whorton, 2002).

APs,
like their CAM cousins, are implausible in natural science terms as well as
lacking in a systematic evidentiary foundation. Some are based on a belief in
an energy system that is not measurable by natural-scientific methods; for
example, Thought Field Therapy (Callahan, 2001) assumes that tapping or
gesturing on or near body parts can change the flow of an untestable energy and
thus affect mood and behavior. Other APs use different concepts that are
contradicted by natural science. Primal Therapy (Janov, 1970) and the belief in
the Primal Wound suffered by adopted children (Verrier, 1993) have as
foundations the assumption of “cellular consciousness” that allows memory to be
mediated by individual cells (even sperm and ova) rather than by the nervous
system.

The
definition of APs is rendered more difficult by the fact that some
conventionally-accepted treatments, such as psychoanalysis, contain some
implausible concepts (e.g., catharsis) and lack clear evidentiary foundations.
In addition, APs may or may not deserve classification as Potentially Harmful
Treatments (PHTs; Lilienfeld, 2007; Mercer & Pignotti,2007), a designation
earned when clearly adverse events such as injury or death of the client are documented
following the treatment. Generally, however, an AP is a treatment that lacks
evidentiary support from either randomized or well-designed nonrandomized
controlled trials AND that is also based on
implausible foundations.

APs as Practices of
Cult-like Groups

Are
APs as a general rule cultic in nature? Answering this question brings us up
against the still-evolving definition of “cult”, with its various suggested
criteria, and the fact that few groups actually meet all requirements for
categorization as cults. Rosedale and Langone (n.d.) gave an extensive list of
characteristics that have been suggested as requirements for the “cult”
classification. These include excessive devotion to a person, idea, or thing;
unethical manipulation for purposes of control, for example through social
isolation; information management; promotion of dependency on the group and
fear of leaving it-- all of these aimed
at the promotion of the group leaders’ agendas.
Richardson (1993) cited his own earlier definition of a cult as a small,
informal group with an indefinite authority structure but sometimes with a
charismatic leader, transitory, mystical and evangelistic, and taking its
inspiration from outside the predominant religious culture. In defining
religious cults, as mentioned earlier, Stark and Bainbridge (1979) focused on
groups with no prior tie to established religious bodies in their societies; a
psychological cult may be considered similarly as independent of conventional
psychological thought.

APs
almost by definition involve excessive devotion to an idea and are associated
with claims of success that are unsupported by the research evidence demanded
in conventional circles. Where research evidence is presented, it may involve
weak research designs or unacceptable anecdotes or testimonials. Each AP has
one or more foundational ideas that are implausible in terms of conventional
systems, but the implausibilities are not addressed or explained. APs are also associated with charismatic group
leaders such as Janov (1970), the originator of Primal Therapy, or Jacqueline
Schiff (1970), the advocate of a “reparenting” procedure that proved fatal in
one case. Some AP leaders consolidate their power by commercializing their
methods and allowing access to information only for those who have paid and
enrolled (for example, Roger Callahan’s
Thought Field Therapy); this ploy also prevents outsiders from conducting
well-designed research by concealing the methods of the AP. Proponents of APs
may be made dependent and prevented from leaving the group by fear of the
disapproval of valued colleagues, but they may also find themselves unable to
move to more conventional practices because they have concentrated their
training in unorthodox areas and lack a network or recommendations from
respected conventional practitioners. AP clients too may have cult-like
commitments to the group, and they may be fearful of leaving because of dire
warnings about worsening of their conditions without the AP, or even of
deleterious effects of conventional mental health treatments. In addition, AP
clients may have formed social networks with other committed believers (often
by Internet) and may have developed social and practical habits that prevent
social engagement with those outside the group; in addition, they may have
maintained secrecy about the AP practices out of a wish to avoid criticism from
outsiders, and this secrecy may have limited their social contacts to group
members.

Groups
of AP proponents thus function in a cult-like manner by Rosedale and Langone’s
definitions. They also meet Richardson’s
criterion of being inspired by something outside the predominant religious
culture as well as outside the predominant, conventional views of mental health
professionals. The “something” outside both of these conventional frameworks
involves explanations or practices founded on non-naturalistic, mystical views
of human life; for example, one common tenet of APs is that human beings have
memories stored in all their cells and therefore are able to remember events
that occurred when they were ova or sperm. However, APs do not meet
Richardson’s criterion of informal, non-hierarchical organization, as the
promulgator of the treatment serves as teacher and mentor as well as therapist
to other group members.

Attachment Therapy as an Alternative Psychotherapy

Attachment
Therapy (also known as Holding Therapy, Rage-reduction Therapy, Z-Therapy,
Prolonged Parent-Child Embrace, and so on) is an alternative psychotherapy
originally directed at correcting emotional disturbances such as schizophrenia
and autism (Zaslow & Menta, 1975) but during the 1990s re-invented as a
treatment for adopted children or others said to suffer from attachment
disorders (Cline, 1992 ). It is presently also used for problems of gender
orientation and for marital relationship problems. It has been described as
“cult-like” in nature (Mercer, Sarner, & Rosa, 2003), but without any
specific analysis of its cultic characteristics. Although the treatment has
been rejected by professional organizations (e.g.Chaffin et al, 2006), its
practice has continued and was recently approved by an article in a
professional journal (Sudbery, Shardlow, & Huntington, 2010).

Following the death of a ten-year-old patient,
Candace Newmaker, in 2000, as well as other documented deaths (Mercer, Sarner,
& Rosa, 2003), Attachment Therapy (AT) is said to have altered in its
practices, although some practitioners appear to have continued to use the
original style. AT is, or was, a physically-intrusive proceeding based on the
implausible assumption that adult physical force and dominance are causes of
young children’s emotional attachment to their parents. AT uses a number of
terms derived from Bowlby’s (1982) conventionally-accepted work on emotional attachment,
but ignores Bowlby’s description of the timing of developing attachment in
favor of the implausible belief that infants form emotional attachments to
their mothers before birth and are traumatized by separation from the birth
mother no matter how early it occurs. AT also attributes child disobedience,
mood, or behavior problems to the absence of attachment, and predicts that adopted children will grow up to be serial
killers even if presently asymptomatic. AT practitioners claim to create
attachment by re-enacting with children the dominance relationship that they
believe is the normal cause of continuing attachment following birth. AT is thus implausible in the context of
conventional understanding of early development; in addition, it lacks an evidentiary
foundation (see Mercer, Sarner, & Rosa, 2003).

Proponents
of AT sometimes state that the children they treat are diagnosed with Reactive
Attachment Disorder (RAD), but in fact the stated symptoms (such as “crazy
lying”) do not meet published criteria for the RAD diagnosis (American
Psychiatric Association, 2000). An alternative diagnosis, Attachment Disorder tout court (AD), is often offered. AD is
diagnosed on the basis of a lengthy list of symptoms, as given in the Randolph
Attachment Disorder Questionnaire (RADQ; Randolph, 2000) or on many related
websites (e.g., www.attachmentdisorder.net).
This list includes intense control battles, unwillingness to show affection on
the parent’s terms, lack of eye contact except when lying, lack of conscience,
incessant chatter, and a fascination with blood and gore.

According
to AT proponents, conventional treatments exacerbate the children’s conditions,
but AT may cure them. The intervention is deliberately intimidating,
frightening, and physically intrusive, as therapists or parents hold the child
down or lie on top of him, poke and prod at his or her body, shout, threaten
abandonment, and demand that the child “confess” by repeating the therapist’s
statements about misdeeds or culpable thoughts like a wish to kill the mother
(Mercer, Sarner, & Rosa, 2003). Dire predictions to the effect that the
child will be “the next Jeffrey Dahmer” may be included. These methods are
repeated for several hours at a time, sometimes day after day, as the child is
put through a two-week “intensive” treatment. After a treatment session, the
child goes to a respite/therapeutic foster family rather than rejoining his
parents; at the respite home, he is given assignments of tedious work, and has
limited diet and other comforts. If the child returns to the parental home, he
or she may be required to ask for permission for anything needed, including use
of the toilet, in an age-inappropriate way.

The
cult-like characteristics of AT include the drawing of its ideology from
outside either the predominant religious culture or predominant beliefs of
mental health professionals (see Richardson, 1993). Although the list of
characters has been changing since the death of Candace Newmaker led AT
proponents to reposition themselves, a small number of prominent members form
the group’s leadership, followed in the hierarchy by a larger number of those
trained within the group. As Rosedale and Langone suggested, the financial
affairs of the AT group are directed primarily to the benefit of these leaders.
A parent-professional group, the
Association for the Treatment and Training of Attachment in Children (ATTACh)
provides courses taught by major figures in the group and leading to
certification as “Registered Attachment Therapist”, a title unrelated to any
professional licensure; however, conventional organizations like the National
Association of Social Workers provide approval for continuing education credits
earned through such courses. Parents of children receiving AT form the lowest
echelon of the group and support each other in the face of conventional critics
by means of Internet sites like www.RadZebra.org
and www.AttachChina.org. Discussion at these sites emphasizes the
ignorance of conventional sources and the need to turn to the group for support
of unconventional beliefs and practices. Contributors who disagree with the
group are intensely criticized by other members, and because contributions are
anonymous, these exchanges take on the viciousness so often found on the
Internet. Information management
techniques convince parents that their children will grow up to be serial
killers if not treated by AT methods, and that conventional psychotherapies are
not only useless but will exacerbate problems. These threats produce fear of
leaving the group and add to the cultic nature of the organization. Payment for
AT services is out-of-pocket rather than by health insurance, potentially
creating cognitive dissonance for those who might consider recanting after
making this expensive choice.

Who
are the members of the AT group, and what advantages do they derive from their
membership? AT’s primary focus on childhood mental illness means that the
people most affected by the belief system are children and not in a position to
make their own decisions about their involvement. Although personal
communications suggest that some children buy into the beliefs presented to
them and grow up assuming that AT is a conventionally-accepted therapy, and
although most of the children cooperate with the treatment for various reasons,
the children do not seek the treatment and therefore are not the cult members
in the usual sense. The decision to belong to the group rests with adults, who
are the actual members. Leadership of the group belongs primarily to AT
practitioners, who show their authority through child diagnosis and treatment
decisions as well as through published material, videos, Internet sites, and
training workshops (which in some cases are given continuing professional
education credits by approved providers certified by the American Psychological
Association and the National Association of Social Workers; the approved provider
system does not require the national organization to approve of individual
presentations).

In
a recent publication of ethnographic observations of AT around 2000, Stryker
(2010) discussed the involvement of adoption caseworkers and agencies as well
as parents in facilitating involvement with AT. Stryker pointed out that both
parents and caseworkers were rewarded by the sense of participating in family
formation. They emphasized the perceived criticism of adoptive parents by
conventional psychotherapists and repeated to each other the belief that
conventional methods exacerbate the childhood mental health problems they had
identified, thus confirming their membership in the group and differentiating
the group’s practices from those in the larger society. Both caseworkers and
practitioners provided a comforting re-frame in the not infrequent case of
disrupted adoptions, by describing the placement of a child in a residential
treatment facility (usually to stay there until “aging out” at 18) as “loving
at a distance”. The adoptive parents were encouraged to consider themselves and
the separated child as a family although there might be no contact between
them. These beliefs contradicted conventional thinking about family ties, and
once again contrasted the supportive attitudes of the AT group with the
criticism to be expected from the larger society. In similar contrast of
conventional and group positions, AT chat groups on the Internet often
mention disapproval of AT methods by
friends and family members and describe the intense need for support by other
AT proponents; a repeated theme in these chats is that no one can understand or
help with their problems unless that person has an adopted child, thus
effectively limiting sources of help or information to group members. (Adoptive
parents who report no particular problems are said to be “in denial” or lying.)

At
a practical level, AT practices provide parents with freedom from child care
responsibilities for days or weeks at a time, or even permanently, outcomes
that would not be encouraged in most cases by conventional child mental health
interventions. In one case in Georgia (in which I testified as an expert
witness), AT-oriented caseworkers managed disruption of an adoption and
adoptive placement of a child with another family, without a conventional
family evaluation, and apparently simply through influence on a judge; when the
child ran away from the new home where she was receiving AT treatment, she was
placed in an AT-oriented facility in another state. Experience of these unconventionally
parent-friendly practices helps to hold members in the group.

A Religious Framework:
Deliverance Beliefs

The
purpose of this paper, as stated earlier, is to examine the connections between
an AP and a religious group, each of which meet some of the criteria for
classification as cultic. The possible religious parallel to AT is the commitment
to “deliverance” beliefs and practices, as evinced by Pentecostals and other
charismatic Christians.

As
is well-known, traditions of exorcism of evil spirits date back to ancient
times. Roman Catholic rituals for exorcism were formulated in the 17th
century, as were those of the Church of England (Malia, 2001). However, Pentecostal
deliverance practices are not obvious developments of the Renaissance
tradition. The older rituals did not consider the capacity for deliverance (the
expulsion of demons) as a gift of the Holy Spirit, and as one among several
gifts said to have been received by the Apostles at the event celebrated as
Pentecost or Whitsunday, and described in the New Testament Book of Acts.
Neither were the spiritual gifts, which included “speaking in tongues”, part of
the periodic religious revivals experienced in North America in the 18th
and 19th centuries. The Pentecostal practice of glossolalia
apparently emerged in about 1830 in a British millennial Presbyterian group
known as the Catholic Apostolic Church (Ellis, 2000). The practice of “pleading
the Blood” and preoccupation with Jesus’ blood as a way of exerting power over
both physical and spiritual worlds began in the early 1900s, and was formalized
as a method of casting out spirits in a book by the Pentecostal author H.A.
Maxwell White in 1959.

These
developments paralleled the growth of the Pentecostal belief that the
“indwelling” of demons in human beings is responsible for mental illness as
well as for physical problems (see Mercer, in press). More recently, manuals of
deliverance (Banks, 1985/2008; Hammond & Hammond, 1973/2010, 1996/2010; Wagner,
2000 ) have described causes of mental illness and outlined methods of
expelling the related demons; these authors agree that expulsion of demons/evil
spirits involves coughing or vomiting out physical substances.

Is
Pentecostalism a cult, or a loose organization of cult-like groups? To
understand Pentecostalism, it is first
necessary to recognize it as a religion, one of several “solutions to ultimate
meaning which postulate the existence of a supernatural being , world, or
force, and which further postulate that this force is active, that events and
conditions here on earth are influenced by the supernatural” (Stark &
Bainbridge, 1979, p. 119). In describing
religious cults, Stark and Bainbridge identified these groups as having no
prior tie with established religious bodies in their societies, and in that way
differing from schismatic sects. The beliefs of religious cults may have been
imported from an alien group, or they may be innovations with a background in
the same society.

Pentecostal
churches are associated with each other, but there is no over-riding
hierarchical organization or statement of dogmas to be accepted by all
Pentecostals. Constant schismatic splitting means that any specific church may
have somewhat different beliefs and practices from others. Nevertheless, there
is sufficient agreement among the groups for them to share publications that
discuss deliverance and associate it with healing of mental and physical
disorders. These publications and other
Pentecostal materials suggest that the group is cultic in nature.

Pentecostals
believe that each Christian experiences a direct connection to God and is a
potential recipient of the gifts of the Holy Spirit discussed earlier.
Religious training or ordination have little importance in the development of
group leaders, so that any individual who is “charismatic” (in the common
meaning of the term) can exercise authority. Members of the congregation are
devoted to these leaders (as Rosedale and Langone suggest), and the informal
and schismatic nature of the group means that any leader who does not inspire
devotion can quickly be left behind. Pentecostals are also devoted to the idea
that their lives are simultaneously involved with the natural and the
supernatural worlds, in a real day-by-day connection as well as a concern with
the afterlife. This belief, unshared with the great majority of
non-Pentecostals in the developed world, sets the group apart and provides a
strong motivation to remain engaged with similar believers; non-Pentecostals
are thought to behave dangerously and attract evil spirits by their casual
involvement with the occult (e.g., Halloween) and by their ignorance about
association with owl figures or the telling of ghost stories (an innovative
position, as suggested by Stark and Bainbridge). A positive reason for staying
with the group stems from the Pentecostal adoption of “prosperity theology” and
the assumption that right belief and behavior wins the gifts of this world as
well as those of the Holy Spirit (Roberts & Montgomery, 1966). However,
although Pentecostals may fear leaving the group, and desire the “compensators”
they associate with membership, they may feel under less pressure than many
cult members, as they believe that they are individually capable of receiving
the gifts of the Holy Spirit (although paradoxically they consider successful
deliverance to depend on confession of sins). In addition, Pentecostals as a
group assume that every person will sometimes “backslide” and that noncompliant
behavior should not necessarily cause expulsion from the group.

Deliverance Beliefs and Choices of Mental
Health Intervention

The
brief history of deliverance beliefs and practices in the last section shows a cult-like
organization with a rich source of metaphors that can be applied to
consideration of mental illness. These metaphors have the potential to shape
preferences or acceptance of APs that are not in themselves directly
deliverance-related. The stress deliverance believers place on the supernatural
may provide metaphors encouraging acceptance of non-material factors in
explanations of mental illness. These non-material factors may involve posited spiritual components such as demonic presences
or the Holy Ghost, undetectable by
physical measurement, that are said to underlie physical and mental
functioning. They may also involve pre-existing and immortal personality
components that enable the individual to remember events during embryonic life,
or even prior to conception. AP treatments almost invariably posit factors of
these types, and conventional treatments do not, so it can be hypothesized that
a preference for AP mental health interventions can result from metaphors
derived from deliverance beliefs. Such metaphors could result simply from
exposure to these beliefs, and would not necessarily require a serious
commitment or conversion.

Testing
the hypothesis that AP preferences are encouraged by exposure to deliverance
beliefs is not within the realm of practical politics. As an alternative, and
with the goal of accumulating evidence relevant to this issue, this paper will
now discuss resonances between deliverance beliefs and one AP mental health
intervention, AT, described earlier. It is notable that Nancy Thomas, a
long-time proponent of AT, is mentioned with admiration by at least one
deliverance-related website, as are a number of books advocating AT
(“Ministering to deeply troubled children”, n.d.). I am well aware of the
dangers of cherry-picking information and of the inappropriateness of
displaying only those points that support my hypothesis, but for obvious
reasons I will not attempt to list all those hundreds of ways in which AT does not resonate with deliverance beliefs,
and will presume that readers understand why I am taking this preliminary approach.

What
are the resonances between AT and deliverance beliefs and practices? The most obvious parallel is an element of
the supernatural, shown by the AT claim
that unborn infants communicate with and know their mothers through means that
are unstated but that cannot include natural sensory modes or the level of
cognition usually attributed to the human fetus (Verny, 1983). The unborn child is considered to have
abilities that are superior to those of a neonate, an implausible idea given
that earlier development is invariably characterized by less mature capacities
than is later development. The implication is that the unborn child retains the
abilities of its spiritual origins, which are more advanced than allowed by the
material nature following birth.

In
addition to the supernatural theme, resonances between deliverance and AT can
be seen in both diagnostic approaches and treatment methods. Some of the
parallels, like that between being “born again” and the “rebirthing” techniques
sometimes associated with AT, are obvious, but most are less apparent unless
examined in detail. The information used for this examination in the next
section will be drawn from Hammond & Hammond (1973/2010; 1996/2010) or
Banks (1985/2008) if it is not otherwise attributed.

Diagnostic
Approaches

Several diagnostic themes are shared by deliverance and
AT proponents, although the two use different language to describe them.
Generally speaking, these shared items are not found in conventional diagnostic
approaches to Reactive Attachment Disorder, the diagnosis often mentioned for
children who receive AT treatment, or any other mental illness.

Discernment.Deliverance believers consider that it
is possible to receive a divine word of knowledge through a vision, dream,
thought, or mental image, and that this knowledge helps to discern which demons
are causing a problem and why they are present. AT proponents do not state
this, but they present themselves as finding it fairly simple to decide whether
a child has an attachment disorder. They may make this diagnosis over the
telephone after asking the parent to respond to a checklist (this occurred for
Candace Newmaker, a child who died during AT treatment; see Mercer, Sarner,
& Rosa, 2003). Elizabeth Randolph, the developer of the Randolph Attachment
Disorder Questionnaire (RADQ), an assessment often used in AT proceedings,
apparently used her own diagnoses of children as the criterion for validation
of the RADQ (Randolph, 2000). It is not clear whether this is simply a matter
of careless or naïve test development, or whether Randolph believed that she
could accurately discern the child’s condition. Randolph also stated that she
could diagnose attachment disorders by noting the child’s inability to crawl
backward on command (Randolph, 2001), an implausible criterion that would
conventionally be considered to have nothing to do with an emotional disorder.

Control battles.AT checklists are much concerned with
the child’s desire or attempts to control and manipulate others. Disobedience,
lack of gratitude, and failure to show affection on the parent’s terms are all
seen as symptoms of attachment disorders. Deliverance practitioners similarly
see an intense desire for control as a sign of demonic possession. In addition,
parents are advised to quell disobedience at all costs (Pearl & Pearl,1994).

Fascination with blood and gore. Although an obsessive interest in blood might
well indicate emotional disturbance of some kind, the DSM-IV-TR criteria for
RAD (American Psychiatric Association, 2000) include absolutely nothing related
to blood in any way. As was noted earlier, however, criteria in checklists
about AD, as promulgated by AT advocates, always include the idea that the
child is “fascinated by blood and gore”. There may be a resonance here with the
deliverance theology emphasis on “pleading the Blood” and “the power of the
Blood”. H.A. Maxwell White’s 1959 book on this topic stressed the great
spiritual significance of blood, its use in sacrifice, and the Biblical idea
that “the blood is the life”. Because AT proponents are concerned with children
seeking to control adults, they may read an interest in blood as a desire for
control in a spiritual as well as the obvious material sense.

Lying. Excessive fantasy or efforts at deception may
also be symptomatic of emotional disturbance , but again play no part in the
criteria for RAD. However, Attachment Disorder checklists, used by AT practitioners,
emphasize habitual lying, especially what they call “crazy lying”-- lying that will obviously not be believed.
Demons are thought of as liars, and are of course under the management of
Satan, the “father of lies”. In addition to their lying propensities, demons
are considered to be highly legalistic and to be permitted to lie about or
refuse to answer a question that is not asked in exactly the right way. Demons
are thought to lie in order to escape from deliverance proceedings without
giving up their “indwelling” of the victim’s body.

Eye contact.
Although eye contact is unmentioned in descriptions of the criteria for RAD,
and although mutual gaze is a behavior much influenced by cultural demands,
failure to make eye contact except when lying is mentioned by AD checklists,
and eye contact upon demand is part of AT practice. Deliverance proponents in some cases regard
the appearance of the eyes and of the gaze as revealing demon possession, as if
the eye is not only literally “the window of the soul”, but a window into
whatever spirit entity is inside a body. Hammond and Hammond (1973/2010) considered
that a glazed or fixed appearance of the eyes could reveal whether a demon or
the person himself was responsible for speech or movement. (It is also possible
that the AT concern about this symptom was adopted from information about
communicative behavior problems in autism.)

Chatter.AT proponents
suggest that attachment disorders are characterized by the child’s constant
chatter and “silly” questions, for example about when they will see their
parents again (Thomas, 2000), and advise caregivers to refuse to answer or to
answer with another question. Deliverance practitioners caution against
yielding to the temptation to exchange banter or persiflage with demonic
entities who are being addressed during a deliverance event; demons are thought
to use words to confuse issues as well as to lie. “Speaking in tongues”, a gift
of the Holy Spirit, involves chatter and incomprehensible speech or singing,
but in its own context is seen as sacred rather than diagnostic of demonic
possession.

History of adoption.The conventional
criteria forRAD are unusual in their inclusion of
etiology as a factor to be considered along with behavior symptoms. A history
of early neglect or abuse, or inconsistent care, is necessary but not
sufficient for a diagnosis of RAD. Adoption
in itself would not be considered relevant to RAD, unless it occurred when the
child was older, or was accompanied by experiences of neglect or abuse. AT
proponents, however, emphasize the posited role of adoption in interfering with
attachment and creating AD (see Keck & Kupecky, 2009; the publisher of this
book is described as the publishing ministry of an international Christian
organization). Infants adopted in the first days of life and cared for well and
consistently are nevertheless thought to be susceptible to AD. This view
parallels the serious concern of deliverance believers with respect to the
attraction of demons by events preceding adoption, including the death of a
parent, conception outside wedlock or through violence and lust, or under circumstances
such that one or both parents consider the possibility of abortion. Adopted
children are considered to be vulnerable to demonic possession through both the
biological and the adoptive family lines, so generational curses based on
ancestral behavior are exceptionally likely to be at work in adopted persons
(Hammond & Hammond, 1973/2010; 1996/2010).

Incontinence. Accounts
of cases by AT practitioners often note that children urinated or defecated
inappropriately (Thomas, 2000). Incontinence is attributed to demonic
influences by deliverance authors.

Treatment

AT and deliverance practices share a number of
procedures; expected behaviors of persons in treatment also have some
similarities. These shared items are not found in conventional scenarios of
treatment for mental health problems.

Restraint.Although physical restraint of persons
in treatment is sometimes used for safety and security reasons, restraint is
not conventionally considered to be of psychotherapeutic value. On the
contrary, recommended goals are for reduction in the use of restraint and
seclusion even outside the therapeutic situation . In AT thinking, however,
restraint itself is thought to be of therapeutic benefit , whether as applied
provocatively to an initially calm client (Cline, 1992; Zaslow & Menta,
1975), or to one who is already agitated (Federici, 2001; Ziegler, 2001). Deliverance practices involve parallel
uses of restraint, whether applied when the deliverance candidate begins to
thrash and fight, or initially, when a child might be held on the lap of a
deliverer or a parent.

Eye contact.Although conventional therapists use
gaze signals as part of their communication with a client, they do not regard
eye contact as a magical or transformative event. AT practitioners, however,
consider the maintenance of eye contact to be a powerful tool. While
restraining a child across the adult’s lap, or while lying on top of the child,
the practitioner insists on a prolonged mutual gaze and scolds or threatens the
child if he or she does not comply. The child is especially to look into the
therapist’s eyes while making confessions or repeating therapist-supplied
statements about feelings. Similarly, deliverers consider eye contact a useful
tool for communication of commands to demons, although they appear to recognize
that mutual gaze cannot be forced.

Confession.
Many conventional psychotherapies involve disclosure of actions, thoughts, and
feelings that a client may have wished to keep secret in the past. In AT
procedures, children are often told what feelings they must have (e.g., hatred
for the biological mother, rage against the adoptive mother) and what actions
they must have wished to carry out. They are instructed to shout related
statements (“I want to kill my Mom!”) repeatedly, and are informed that if they
do not change they will actually do these things and will go to prison (Mercer,
Sarner, & Rosa, 2003). In deliverance proceedings, confession of thoughts
or behavior that could attract demons is a prerequisite to the casting out of
those demons. “Occult” activities, like celebration of Halloween or use of a
Ouija board, must be described as well as more obviously prohibited activities
involving sex or drugs. In a parallel with AT, what is confessed might never have
been acted on, as in the case of a considered abortion (Hammond & Hammond, 1973/2010).
Deliverance proceedings include the verbatim repetition of prayers by the
deliverance candidate and the deliverance team. One point of interest is that
in the course of deliverance, confessions that are spoken may not be clearly
identified as information from the deliverance candidate; the demon might be
speaking and lying.

Vomiting.Vomiting, urination, and defecation
are not expected events during most conventional psychotherapy, and if they
occur are considered symptoms of physical illness or of a child’s immaturity.
In AT practice, however, these physical actions are regarded as completely
under the control of the child and as used to resist the therapist’s pressures
for change. A much-quoted paper by Reber ( 1996) described children in AT as
vomiting, begging to use the toilet, and crying that they were going to die,
and positioned these behaviors as normal parts of the therapeutic proceeding
(this paper, incidentally, was cited by Furnari [2005]) . The AT-associated
death of Candace Newmaker in 2000 involved the child’s vomiting while
restrained inside a rolled sheet; several adults present ignored this and its
potential for serious harm, apparently considering it a normal part of
treatment. Deliverance proceedings, in a striking parallel, are not only
tolerant of vomiting, but consider vomiting and coughing phlegm as indices of
the expulsion of demons and therefore as desirable (Bialecki, 2011; Cuneo,
2001). Preparation for the deliverance includes provision of containers and
towels. Again, incontinence may be interpreted as a sign of demonic possession.

Fasting.Conventional psychotherapies assume
that good physical health is advantageous for successful mental health
interventions. AT practices, on the contrary, hold that respite or therapeutic
foster care practices encourage emotional change when they limit the amount and
variety of children’s diets (Thomas, 2000), or force food or water as a way to
obtain compliance (Mercer, Sarner, & Rosa, 2003). Deliverance believers use
fasting as a method of purification that is helpful to the deliverer’s
abilities, but they may also advise the deliverance candidate to prepare
himself through fasting and prayer. I have found no evidence that fasting is
imposed on children, however.

Number and length
of treatment sessions.Conventional
psychotherapies often use the standard “fifty-minute hour” and employ sessions
that occur weekly, or not much more often. AT sessions last for several hours,
and although they sometimes occur weekly, are much more frequent in the case of
the two-week “intensive”. Deliverance events also last several hours, and
although they are not at daily intervals, they are generally repeated on a
number of occasions, especially because it is thought that the same demons may
return, or other demons may be attracted to the “empty” person.

Practitioners.Licensure for
conventional psychotherapists attempts to ensure an appropriate level of
training. Some AT practitioners have found some ways to avoid such
requirements. They may practice in a state like Colorado, where therapists may
be registered but unlicensed, or may work under the cover of a sympathetic
licensed practitioner. These options permit a AT therapist to limit training on
some topics to weekend seminars (as was the case for Julie Ponder, one of the
persons responsible in the death of Candace Newmaker), or to claim the
credential of “registered attachment therapist” as provided by the Association
for Treatment and Training of Attachment in Children (ATTACh). Some AT
practitioners have doctoral degrees from intermittently-accredited
organizations like the Union Institute. Some have sought licensure as massage
therapists in order to avoid restrictions on physical contact with patients.
Deliverance practitioners have similar training issues. Pentecostal groups are
highly congregational in organization, so the hiring of pastors is based
entirely on the wishes of an individual church, and there is no denominational
set of standards for educational background. Deliverers learn informally from
each other, unless they themselves wish to study conventional materials; there
is no encouragement or requirement for any formal training in any
mental-health-related area. Indeed, their training may depend on items like the
Demon possession handbook for human
service workers (1995).

Further concerns. A
still unexplored issue in the continuing development of both deliverance
beliefs and acceptance of APs is the influence of African Pentecostalism. This
set of beliefs, which to some extent combines African traditional religions
with Pentecostal tenets (Asamoah-Gyadu, 2004), began with missionaries to
Africa from the United States, but may be affecting U.S. Pentecostals in return
as African evangelists return to preach and carry out deliverance in the United
States. An event of recent concern was
the planned (but postponed) visit of the Nigerian evangelist Helen Ukpabio, who
has been associated with many accusations of children as witches, followed by
torture and death of the children (Ngong, 2010; “Marathon deliverance”, 2012).

Conclusion

“Deliverance”
believers and AT proponents both form groups that meet some criteria associated
with cults. Although cult-like groups may be expected to compete rather than
cooperate with each other, these two groups, which have different apparent
goals, share practices and beliefs to such an extent that they seem to be
mutually influential. However, the much longer history of Pentecostalism, as
well as its far broader concerns, suggests that Pentecostal beliefs and
metaphors are more likely to have influenced AT than the other way around.

Theparallels between deliverance
practices and AT are clear, but there may well be an equal number of
non-parallel characteristics. As I noted earlier, I can hardly conclude that
the existence of many parallels between a religious framework and an AP
necessarily means that religious beliefs increase the acceptability of the
treatment to believers. However, it is noteworthy that there appear to be many
more overlapping factors between deliverance practices and AT than there would
be between, say, deliverance practices and conventional psychotherapies like Parent-Child
Interaction Therapy (Eyberg & Bussing, 2010) or DIR/Floortime (Greenspan
& Wieder, 2006). Neither of the latter
two treatments (one with and one without a clear evidence basis, but
both highly plausible) employs restraint or the forcing of eye contact or
confession; both emphasize following the child’s lead as an essential part of
establishing a good relationship, rather than seeing a controlling parent as
one who is fostering a child’s attachment.

Understanding the possible role of religious beliefs in
encouraging clients to choose AP treatment is especially important because of
the potential for harm in some unconventional methods. That potential goes
beyond the expenditure of scarce resources on ineffective treatment, or even
the possible avoidance of evidence-based treatment because of advice from AP
practitioners. Both deliverance practices and AT have been associated with
injuries and deaths (“Autistic boy’s death at church…”, 2003; “Police: ‘Cult’
starved toddler…”, 2008; Mercer, Sarner, & Rosa, 2003). They deserve to be categorized as Potentially
Harmful Treatments (Lilienfeld, 2007; Mercer & Pignotti, 2007) and to have
their beliefs and practices publicly vetted for the benefit of those who may be
attracted to these cult-like organizations. Some vetting is currently
proceeding in a British case discussed at http://invisibleengland2.wordpress.com,
as well as in a case in the U.S. in which a man in his 30s is seeking redress
for being confined and treated with AT for eight years of his childhood.

Practical
Effects of Differing Social Environments

Although this paper has called attention to resonances
between a cult-like psychotherapy and a cult-like religious system, these two phenomena
cannot be argued to be identical. Psychotherapeutic cults and religious cults
(assuming that both exist) operate under very different social pressures and
are thus forced to behave differently in related ways.

Religious
leaders need not be licensed or conform with specific guidelines or messages
unless they belong to established groups that ordain clergy who are to teach
agreed-upon dogma. Religious leaders may volunteer their services or may be
paid a salary by a congregation, but generally do not perform fee-for-service
work in the usual sense. There is no
pressure for leaders of religious cults to state their conformity with the
beliefs of established groups; on the contrary, their positions may be
strengthened by clear antagonism to conventional beliefs and practices. There
is thus little beyond the opinions of group members to encourage the group to
resemble established religious systems.

Psychotherapists,
on the other hand, cannot ordinarily practice, advertise, or identify
themselves as such without some degree of approval of the larger society. That
approval is generally based on the approval of established professional groups
that work to the benefit of conventional belief systems and practices. Although
there are some states in which unlicensed psychotherapists have practiced,
alone or under the direction of another practitioner, licensure is a common
requirement and is based on meeting conventional standards of education and
training. Unless the unlicensed practitioner can find a licensed individual to
handle billing and other arrangements, he or she will be unable to receive
third-party payment. Without the salary that a religious leader often receives,
the unlicensed AP practitioner may be unable to make a living unless he or she
can convince potential fee-paying clients of the efficacy of the treatment. To
accomplish this involves a high level of information management. In the present
era of emphasis on evidence-based treatment, AP practitioners make claims about
the way their treatment “works” and count on the inability of the client to
understand the systematic evidence required to make such claims (Mercer, Pennington,
Pignotti, & Rosa, 2009).

AP
practitioners also provide rationales for their practices that allude to
respected psychological authors whose theories are foundational to conventional
approaches; for instance, AT proponents frequently reference John Bowlby, the
originator of attachment theory, even though the AT concept of attachment is
quite different from that proposed by Bowlby (see www.attach.org for examples). AP practitioners
recognize current assumptions in conventional psychotherapy and attempt to
position their treatments either in contradiction or in compliance with them.
In AT circles, for example, authors in the 1990s argued against the
conventional child psychotherapy dictum of “following the child’s lead” and
declared that such practices would exacerbate childhood mental illness.
Following the death of Candace Newmaker and the repositioning of AT thinking,
AT authors have responded to guidelines requiring informed consent of clients
to treatment by claiming that children are always asked if they agree to being
held, a claim that ignores the conventional view that children are in fact not
capable of informed consent, and that bypasses the more important requirement
that parents and guardians must be fully informed of risks and benefits before
giving their consent to treatment. Some AP proponents have addressed their
practical need to appear in conformity with conventional practices by insisting
that professional journals were unfairly excluding submitted papers; in 2001,
the editor of the Journal of Clinical
Psychology permitted non-reviewed publication of papers about the AP Thought
Field Therapy (Callahan, 2001) in order to show openness on this point.

These
practical issues may conceal the resemblances of the religious and the
psychotherapeutic groups to each other, and their sharing of cult-like
characteristics. Nevertheless, as this paper has shown, the two belief systems examined
here have much in common. The same may be true of other cult-like religious and
psychotherapeutic groups, but in order to determine this it is probably
necessary to compare the details of specific groups with each other rather than
attempting a broad comparison of all
groups of each type.

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About Me

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.